Apparatus for adjustably supporting an endoscope

ABSTRACT

An apparatus ( 100 ) supports an endoscope ( 99 ) for viewing a surgical site in a patient during surgery on the patient. The apparatus ( 100 ) includes a base ( 110 ), a first part ( 200 ), a second part ( 300 ), and a mechanism ( 400 ). The base ( 110 ) has a guide portion ( 130 ). The first part ( 200 ) is adapted to be fixed to the endoscope ( 99 ). The second part ( 300 ) engages the guide portion ( 130 ) and is movable relative to the guide portion ( 130 ). The second part ( 300 ) is secured to the first part ( 200 ) such that the first part ( 200 ) is movable relative to the guide portion ( 130 ). The mechanism ( 400 ) is connected between the base ( 110 ) and the second part ( 300 ). At least a portion of the mechanism ( 400 ) is rotatable to slide the first and second parts ( 200, 300 ) relative to the guide portion ( 130 ) to change a position of the endoscope ( 99 ) relative to the patient.

TECHNICAL FIELD

The present invention relates to an apparatus for adjustably supportingan endoscope and, more particularly, for supporting an endoscope forviewing different areas at a surgical site in a patient during surgeryon the patient.

BACKGROUND OF THE INVENTION

Percutaneous surgery is a procedure in which surgical instruments, andtypically an endoscope, are inserted through a cannula into the body ofa patient. A viewing element, typically a small video camera, is part ofthe endoscope and is connected to a television monitor so that thesurgeon may view the surgical site.

The cannula is a hollow tube. The cannula is inserted through anincision into the body of a patient. The instruments and the endoscopeare inserted through the cannula. The cannula also allows theinstruments and endoscope to be removed from the body and/or adjusted inthe body during the surgery.

A conventional apparatus for supporting the endoscope allows a surgeonto manipulate the surgical instruments without also moving theendoscope. Also, a known support apparatus allows adjustment of theendoscope relative to the cannula for viewing different areas at thesurgical site.

SUMMARY OF THE INVENTION

In accordance with one feature of the present invention, an apparatussupports an endoscope that extends through a cannula for viewing asurgical site in a patient during surgery on the patient. The apparatusincludes a base, a first part, a second part, and mechanism. The base isassociated with the cannula and has a guide portion. The first part isadapted to be fixed to the endoscope. The second part engages the guideportion and is movable relative to the guide portion. The first andsecond parts are movable together relative to the guide portion. Themechanism is connected between the base and the second part for movingthe first and second parts relative to the guide portion to change aposition of the endoscope relative to the patient.

In accordance with another feature of the present invention, anapparatus supports an endoscope for viewing a surgical site in a patientduring surgery on the patient. The endoscope extends through a cannulainto the patient. The apparatus includes a base and a cannula retainer.The cannula retainer engages an outer surface of the cannula to securethe cannula to the cannula retainer. The cannula retainer includes asplit ring for engaging a groove on the outer surface of the cannula anda sleeve for receiving the cannula and supporting the split ring. Thebase is rotatable relative to the sleeve about an axis of the cannula.

In accordance with still another feature of the present invention, anapparatus supports an endoscope for viewing a surgical site in a patientduring surgery on the patient. The endoscope extends through a cannulainto the patient. The apparatus includes a base, a sleeve, and a sleeveretainer. The base supports the endoscope. The sleeve engages an outersurface of the cannula. The base and sleeve are relatively rotatableabout an axis of the cannula. The sleeve retainer supports the sleeveand the base. The sleeve retainer includes a member press fit onto anend portion of the sleeve.

In accordance with yet another feature of the present invention, anapparatus supports an endoscope for viewing a surgical site in a patientduring surgery on the patient. The endoscope extends into a cannula andinto the patient. The apparatus includes a base, a sleeve, and a supportarm. The base supports the endoscope. The sleeve engages an outersurface of the cannula. The base and sleeve are relatively rotatableabout an axis of the cannula. The support arm secures the sleeve to asupport structure. The support arm includes a first portion forconnection to the sleeve and a second portion for interconnecting thefirst portion and the support structure. The first portion comprises anelectrically insulating material electrically insulating the sleeve fromthe second portion.

In accordance with still yet another feature of the present invention,an apparatus supports an endoscope for viewing a surgical site in apatient during surgery on the patient. The apparatus includes a base, afirst part to be fixed to an endoscope, a second part, a screwmechanism, and a pin. The base has a guide portion. The second part ismovable in the guide portion and connected with the first part. Thefirst and second parts are movable together relative to the guideportion. The screw mechanism is connected to the second part and isoperable to move the first and second parts relative to the guideportion. The pin secures the second part to the screw mechanism. The pinis press fit into recesses in both the second part and the screwmechanism.

In accordance with yet another feature of the present invention, anapparatus supports an endoscope for viewing a surgical site in a patientduring surgery on the patient. The endoscope extends through a cannulainto the patient. The apparatus includes a base and a sleeve. The basesupports the endoscope. The sleeve engages an outer surface of thecannula. The base and sleeve are relatively rotatable about an axis ofthe cannula. The sleeve has an internal diameter that increases from aninitial diameter as the cannula is inserted into the sleeve and thatsubsequently springs back toward the initial diameter so that the sleevegrips the cannula.

In accordance with still another feature of the present invention, anapparatus supports an endoscope for viewing a surgical site in a patientduring surgery on the patient. The apparatus includes a base, astructure, and a screw mechanism. The base has a guide portion. Thestructure is adapted to be fixed to the endoscope. The structure engagesthe guide portion and is movable relative to the guide portion. Thescrew mechanism is connected between the base and the structure. Atleast a portion of the screw mechanism is rotatable to slide thestructure relative to the guide portion to change a position of theendoscope relative to the patient. The screw mechanism includes a firstthreaded spindle having female threads and a second threaded spindlerotatable about an axis relative to the female threads in the firstthreaded spindle. The first threaded spindle has a lip portion forlimiting axial displacement of the first threaded spindle relative tothe second threaded spindle.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features of the present invention will becomemore apparent to one skilled in the art upon consideration of thefollowing description of the invention and the accompanying drawings, inwhich:

FIG. 1 is an exploded perspective view of an apparatus constructed inaccordance with features of the present invention;

FIG. 2 is a schematic top view of the apparatus of FIG. 1;

FIG. 3 is a schematic sectional view taken along line 3—3 in FIG. 2;

FIG. 4 is a schematic sectional view taken along line 4—4 in FIG. 2;

FIG. 5 is a schematic view partially in section of part of the apparatusof FIG. 1;

FIG. 6 is a schematic perspective view of a portion of FIG. 5;

FIG. 7 is a schematic sectional view taken along line 7—7 in FIG. 4;

FIG. 8 is a schematic sectional view taken along line 8—8 in FIG. 4;

FIG. 9 is a schematic detail view of part of the apparatus in FIG. 8;

FIG. 10 is an exploded schematic view of part of the apparatus of FIG.1;

FIG. 11 is a schematic view taken along line 11—11 in FIG. 10;

FIG. 12 is a schematic view showing the parts of FIG. 10 with anassociated mechanical arm;

FIG. 13 is a schematic sectional view similar to FIG. 4 showing featuresof the present invention;

FIG. 14 is a schematic detail view of part of the apparatus of FIG. 13;

FIG. 15 is a schematic sectional view similar to FIG. 4 showing featuresof the present invention;

FIG. 16 is an exploded perspective view similar to FIG. 1 showingfeatures of the present invention;

FIG. 17 is a schematic detail view of a part that could be used in theapparatus of FIG. 16;

FIG. 18 is a schematic detail view of part of the apparatus of FIG. 13.

FIG. 19 is an exploded schematic view illustrating an expandable cannulaconstructed for use with the present invention;

FIG. 20 is a perspective view of the cannula of FIG. 19 with partsremoved for clarity, the cannula being shown in a contracted condition;

FIG. 21 is a schematic end view showing the cannula of FIG. 19 in theexpanded position;

FIG. 22 is a rollout view of a part of the cannula of FIG. 19;

FIG. 23 is a schematic sectional view of the cannula of FIG. 19 during asurgical procedure; and

FIG. 24 is schematic detail view of another part that could be used inthe apparatus of FIG. 16.

DESCRIPTION OF A PREFERRED EMBODIMENT

As representative of the present invention, the Figures illustrate anapparatus 100 (FIG. 1) for use in percutaneous surgery in associationwith a cannula 10 (FIG. 20). The apparatus 100 includes a base 110, astructure comprising a first part 200 and a second part 300, a screwmechanism 400 connected between the base and the second part, and acannula clamp 500 connected with the base. The first part 200 is adaptedto be fixed to a camera head 99. The second part 300 is adapted to besecured to the first part. The cannula clamp 500 is adapted to beclamped to the cannula 10. The base 110, first part 200, second part300, and camera head 99 are rotatable relative to the cannula clamp 500.

A conventional cannula is a cylindrical metal or plastic tube with achannel extending completely through the cannula. The channel has acentral axis. The cannula is inserted through an incision into a body ofa patient during surgery.

FIGS. 19-23 illustrate one suitable cannula 10 constructed for use withan apparatus 100. U.S. patent application Ser. No. 09/772,605, filedJan. 30, 2001 in the names of Thomas Davison et al., discloses othercannula structures that may be used with the apparatus 100. A specificcannula structure is not envisioned as part of the present invention.The cannula 10 will be described below by way of example of a cannulausable with the present invention.

The cannula 10 (FIGS. 19-23) is a tubular structure 12 centered on acentral axis 14. The tubular structure 12 defines a passage 16 throughthe cannula 10. Surgical instruments and an endoscope are inserted intoa patient's body through the passage 16 during surgery.

The tubular structure 12 comprises a first tubular portion 20 and asecond tubular portion 40 attached to the first tubular portion. Thefirst tubular portion 20 is preferably made of a length of stainlesssteel tubing, but could alternatively be made of another suitablematerial. The first tubular portion 20 has a proximal end 22 and adistal end 24. Parallel cylindrical inner and outer surfaces 26 and 28,respectively, extend between the ends 22, 24 of the first tubularportion 20. The inner surface 26 defines a first passage portion 30 ofthe passage 16 through the cannula 10. The first passage portion 30 hasa diameter D1 that is preferably in the range from 10 mm to 30 mm.

The second tubular portion 40 of the tubular structure 12 is attached tothe distal end 24 of the first tubular portion 20. The second tubularportion 40 is preferably made from stainless steel, but couldalternatively be made from another suitable material.

As best seen in the rollout view of FIG. 22, the second tubular portion40 comprises an arcuate segment 42 of sheet stock. The arcuate segment42 includes first and second arcuate edges 44 and 46, respectively, andfirst and second planar edges 48 and 50, respectively. The first andsecond planar edges 48 and 50 are rolled in an overlapping manner toform the tubular configuration of the second tubular portion 40.

When the second tubular portion 40 has been rolled into its tubularconfiguration, the first and second arcuate edges 44 and 46 defineoppositely disposed first and second ends 60 and 62 (FIGS. 19 and 20),respectively, of the second tubular portion. The first and second ends60, 62 are connected by a central portion 64. The first end 60 of thesecond tubular portion 40 is attached to the distal end 24 of the firsttubular portion 20 by a single fastener, such as a rivet 66. The rivet66 extends through two aligned apertures 68 (FIG. 22) at the first end60 of the second tubular portion 40. The first end 60 of the secondtubular portion 40 is pivotable about the rivet 66.

The second tubular portion 40 includes parallel inner and outer surfaces70 and 72 (FIGS. 19 and 20), respectively, extending between the firstand second ends 60 and 62. The inner surface 70 defines a second passageportion 74 of the passage 16 through the cannula 10 that extends as acontinuation of the first passage portion 30 in the first tubularportion 20.

An arcuate slot 80 is formed in the second tubular portion 40 andextends between the inner and outer surfaces 70 and 72 of the secondtubular portion. The arcuate slot 80 extends along a curvilinear path inthe central portion 64 of the second tubular portion 40 toward thesecond end 60 of the second tubular portion. The arcuate slot 80 has afirst terminal end 82 located in the central portion 64 of the secondtubular portion 40. A second terminal end 84 of the arcuate slot 80 islocated adjacent the intersection of the second arcuate edge 46 and thefirst planar edge 48 of the arcuate segment 42.

A guide pin 90 is attached to the inner surface 70 of the second tubularportion 40 adjacent the intersection of the second arcuate edge 46 andthe second planar edge 50. In the tubular configuration of the secondtubular portion 40, the guide pin 90 is located in the arcuate slot 80and is movable along the curvilinear path of the arcuate slot. A washer92 is secured to an inner end of the guide pin 90 to retain the guidepin in the arcuate slot 80.

The second tubular portion 40 of the tubular structure 12 is expandablefrom a contracted condition shown in FIG. 20 to an expanded conditionshown in FIG. 19. In the contracted condition, the guide pin 90 islocated in the first terminal end 82 of the arcuate slot 80 in thesecond tubular portion 40 and the second passage portion 74 defined bythe second tubular portion is cylindrical in shape. The second passage74 has a generally constant diameter D2 (FIGS. 20 and 21) that isapproximately equal to the diameter D1 of the first tubular portion 20.Thus, the cross-sectional area of the second passage portion 74 at thesecond end 62 of the second tubular portion 40, which is a function ofthe diameter D2, is approximately the same as the cross-sectional areaat the first end 60 of the second tubular portion and is approximatelythe same as the cross-sectional area of the first passage portion 30 inthe first tubular portion 20.

In the expanded condition, the guide pin 90 is located in the secondterminal end 84 of the arcuate slot 80 in the second tubular portion 40and the second tubular portion has a frustoconical configuration. At thesecond end 62 of the second tubular portion 40, the second passageportion 74 has a diameter D3 (FIG. 21) that is larger then the diameterD2 of the second passage portion at the first end 60. Preferably, thediameter D3 of the second passage portion 74 at the second end 62 of thesecond tubular portion is 40% to 80% greater than the diameter D1 of thesecond passage portion at the first end 60.

Thus, in the expanded condition, the cross-sectional area of the secondpassage portion 74 at the second end 62 of the second tubular portion40, which is a function of the diameter D3, is 16% to 64% greater thanthe cross-sectional area of the second passage portion at the first end60 of the second tubular portion. In the expanded condition, thecross-sectional area of the second passage portion 74 at the second end62 of the second tubular portion 40 may be large enough to overlie amajor portion of at least two adjacent vertebrae of a patient.

The cannula 10 includes an outer layer 31 (FIG. 19) for maintaining thesecond tubular portion 40 of the cannula 10 in the contracted condition.It is contemplated that other suitable means for maintaining the secondtubular portion 40 in the contracted condition could be employed. Theouter layer 31 comprises a section of plastic tubing 32 which is heatshrunk over both the first and second tubular portions 20, 40 to holdthe second tubular portion in the contracted condition.

In addition, a loop of polyester string 34 for tearing the heat shrunktubing 32 is wrapped around the heat shrunk tubing so that it extendsboth underneath and on top of the tubing. An outer end 36 of the string34 extends beyond the tubing 32.

FIG. 19 shows an actuatable device 35 for expanding the second tubularportion 40 from the contracted condition to the expanded condition. Theactuatable device 35 comprises a manually operated expansion tool 37.The expansion tool 37 resembles a common pair of scissors and has a pairof legs 33 pivotally connected to one another. The expansion tool 37includes a frustoconical end section 38 formed by a pair offrustoconical halves 39. Each of the frustoconical halves 39 extendsfrom a respective one of the legs 33 of the expansion tool 37. It iscontemplated that other suitable means for expanding the second tubularportion 40 toward the expanded condition could be employed, such as aninflatable balloon (not shown).

During an endoscopic surgical procedure, the cannula 10 is inserted intothe body 97 of a patient in the contracted condition. The outer end 36of the string 34 is then manually pulled on by the surgeon. Pulling onthe string 34 tears the heat shrunk tubing 32 most of the way along theheat shrunk tubing, which frees the second tubular portion 40 forexpansion. The heat shrunk tubing 32, in its torn condition, may remainattached to the first tubular portion 20.

Next, the expansion tool 37 is inserted into the passage 16 in thecannula 10 until the frustoconical end section 33 is located at thesecond end 62 of the second tubular portion 40. The legs 33 of theexpansion tool 37 are manually separated, causing the frustoconicalhalves 39 to separate also. As the halves 39 separate, a radiallyoutward directed force is exerted on the inner surface 70 of the secondtubular portion 40 by the halves 39, causing the second tubular portionto expand toward the expanded condition. Under the force of theexpanding expansion tool 37, the guide pin 90 slides from the firstterminal end 82 of the arcuate slot 80 to the second terminal end 84 ofthe arcuate slot to permit the expansion of the second tubular portion40. The expansion tool 37 can be rotated about the central axis 14 toensure that the second tubular portion 40 of the cannula 10 iscompletely expanded to the expanded condition. The expansion tool 37 isthen collapsed and removed so that one or more surgical instruments(indicated schematically at 98 in FIG. 23) and an endoscope (indicatedschematically as part of the camera head 99 in FIG. 23) can be receivedthrough the cannula 10 and inserted into a patient's body 97 (typicallyat 15° from vertical as shown in FIG. 23). The expanded second tubularportion 40 of the cannula 10 provides a large working area for thesurgeon inside the body 97.

The expanded tubular portion 40 can dilate and locally retract andseparate spinalis muscle and soft tissues from the vertebrae therebycreating an endoscopic operating field at the surgical site. Thisendoscopic operating field within the spinal muscles differs fromarthroscopic, laparoscopic, or cystoscopic working spaces in that thereis no physiologic space or defined tissue plane that is insufflated withair or distended with fluid.

As viewed in FIG. 1, the apparatus 100 of the present invention may beassociated with the cannula 10 of FIGS. 19-23. The base 110 of theapparatus 100 includes a base portion 120 and a guide portion 130. Thebase portion 120 is typically molded as one piece with the guide portion130. The base 110 may be constructed as a suitable polymer such aspolyetheretherketone (PEEK).

The base portion 120 comprises a first generally cylindrical platform,or first disk 121, and a second generally cylindrical understructure, orsecond disk 122 (FIG. 4). The first disk 121 has an upper circularsurface area 121′. The first disk 121 has a first circular perimeter123, and the second disk 122 has a second, smaller circular perimeter124. A central, circular aperture 125 in the central area of the firstand second disks 121, 122 extends through the disks. The first andsecond perimeters 123, 124 have a center 126 (FIG. 2) located at thecenter of the central aperture 125.

A generally cylindrical sleeve part 600 is secured to the cannula clamp500 by conventional fasteners 599 (FIG. 4). The sleeve part 600 islocated in the central aperture 125. The proximal end 22 of the cannula10 can be easily inserted into, and removed from, the sleeve part 600.When the cannula 10 is located in the sleeve part 600, an axis of thesleeve part extends through the center 126 of the central aperture 125and is coincident with the central axis 14 of the cannula. The axis ofthe sleeve part 600 also extends through the center 126 of the centralaperture 125. Thus, the cannula 10 and the sleeve part 600 areconcentric about the central axis 14.

As viewed in FIG. 3, the guide portion 130 of the base 110 includes ahorizontal base part 132, a first upright member 141 extending upwardfrom the base part, and a second upright member 142 extending upwardfrom the base part. The upright members 141, 142 have respective lowerportions 151, 152 extending upward and parallel to each other. Theupright members 141, 142 further have respective upper portions 161, 162extending upward from the lower portions 151, 152 and toward each other.Each upper portion 161, 162 has a respective vertical, linear track 171,172 for slidingly receiving the second part 300.

The base part 132 of the guide portion 130 has a right-hand threadedbore 134 extending vertically from a lower surface 136 of the base partto an upper surface 138 of the base part. The upper surface 138 islocated between the upright members 141, 142.

As viewed in FIG. 2, one of the upright members 141, 142 may have ahorizontal threaded bore 145 for receiving a stop member 147. The stopmember 147 has a partially threaded shaft with a non-threaded end thatextends horizontally through the upright member 141 or 142 into the areabetween the upright members 141, 142. The non-threaded end acts as avertical limit stop for a part 430 of the screw mechanism 400.

As viewed in FIG. 1, the first part 200 connects to the camera head 99.The camera head 99 consists of a main body portion 99′ and a light port99″. An endoscope (not shown) may be threaded into the main body portion99′ and secured to the main body portion. Part of the endoscope (FIG.23) may thereby extend through the channel 12 of the cannula 10 into thepatient's body 97.

The first part 200 comprises a generally U-shaped body having a passagethrough which the endoscope extends. As viewed in FIGS. 3 and 6, thefirst part 200 includes five planar surfaces and one cylindricallyshaped bottom surface. These surfaces define first and second opposite,generally rectangular guide surfaces 211, 212 (FIG. 3), a generallyrectangular first engagement surface 221 (FIG. 5), a secondcylindrically shaped engagement surface 222 (FIG. 5), and first andsecond opposite, generally rectangular lateral surfaces 231, 232. Theguide surfaces 211, 212 include rail members 215, 216 for slidablyengaging the second part 300.

As viewed in FIG. 5, the passage in the first part 200, through whichthe camera head 99 extends, includes a first generally rectangularpassage portion 241 and a second passage portion 242 sized for receivingand engaging the main body portion 99′. A transition point 243 in thepassage is located where the first passage portion 241 and the secondpassage portion 242 come together.

The first passage portion 241 extends horizontally from the firstlateral surface 231 through about ⅔ of the distance between the lateralsurfaces 231, 232 to the transition point 243. The second passageportion 242 includes a cylindrical passage portion that communicateswith the first passage portion 241 and extends horizontally from thetransition point 243 to the second lateral surface 232. The secondpassage portion 242 forms a first circular opening 245 in the lateralsurface 232. The perimeter of the first circular opening 245 forms asurface for tightly engaging the main body portion 99′ of the camerahead 99.

The first part 200 further includes a slot 255 for receiving the lightport 99″ of the camera head 99 and, an electric cord (not shown) of theendoscope. The slot 255 extends vertically upward from the first andsecond passage portions 241, 242 that receive the main body portion 99′.The slot 255 intersects the first engagement surface 221. The slot 255extends horizontally from the first lateral surface 231 to the secondlateral surface 232 and intersects the lateral surfaces. The portion ofthe slot 255 that is adjacent the first passage portion 241 is definedby curved edges 257 for abuttingly engaging the curved outer surface ofthe light port 99″.

The second lateral surface 232 further includes a second circularopening 259 (FIG. 6). The second circular opening 259 is sized tightlyengage the curved outer surface of the light port 99″. The secondcircular opening 259 has a smaller diameter than the first circularopening 245. The curved edges 257 of the slot 255 extend a part of thecircle defined by the second circular opening 259 from the transitionpoint 243 to the first lateral surface 231.

One of the guide surfaces 211, 212 may have one or two threaded bores217 extending horizontally from the guide surfaces to the first passageportion 241. These bores 217 may have set screws 218, such asconventional threaded fasteners, or ball plungers 700 (discussed below),threaded into them for engaging and releasably securing the camera head99 to the first part 200.

The second part 300 comprises a generally U-shaped body having a passagefor receiving the first part 200. The second part 300 includes fiveplanar external sides and one substantially open end. These sides definefirst and second opposite, generally rectangular guide surfaces 311,312, a generally rectangular bottom engagement surface 321, and firstand second opposite, planar U-shaped lateral surfaces 331, 332 (FIG. 5).

The engagement surface 321 of the second part 300 includes a generallyrectangular slot 323 for receiving a part 423 (FIG. 5) of the screwmechanism 400. The slot 323 extends vertically upward from theengagement surface 321 to the passage of the second part 300.

Each lateral surface 331, 332 is intersected by a respective circularbore 335, 336 extending from each lateral surface to the slot 323. Thebores 335, 336 are coaxial. A cylindrical pin 305 may be inserted intoone of the bores 335, through an opening in the part 423 of the screwmechanism 400 and into the other bore 336 in order to secure the secondpart 300 to the part 423 of the screw mechanism 400. The outer diameterof the cylindrical pin 305 may be slightly larger than the innerdiameter of the cylindrical bores 335, 336 and/or the opening in thepart of the screw mechanism 400 so that a press fit engagement furthersecures the second part 300 to the screw mechanism 400.

The passage of the second part 300 includes two parallel guide tracks315, 316 for slidably receiving the rail members 215, 216 of the firstpart 200. Once the camera head 99 is secured in the passage of the firstpart 200, the camera head and first part may be slid verticallydownward, through the open end of the second part 300, into the passageof the second part along the guide tracks 315, 316 until the secondengagement surface 222 of the first part 200 abuttingly engages the baseof the passage of the second part 300. The base of the passage of thesecond part 300 may be curved for continuous engagement with the secondengagement surface 222 of the first part 200 (FIG. 3). The camera head99 and first part 200 are both thereby secured to the second part 300.The guide tracks 315, 316 of the second part 300 and the rail members215, 216 of the first part 200 maintain the camera head 99 and firstpart 200 in a stable position relative to the second part as the secondpart is vertically adjusted along the guide tracks 171, 172 of the guideportion 130.

One of the guide surfaces 311, 312 of the second part 300 may have oneor two threaded bores 355 extending horizontally from the guide surfacesto the first passage of the second part. These bores 355 may have setscrews 357, such as conventional threaded fasteners, or ball plungers700 (discussed below), threaded into them for engaging and fixedlysecuring the first part 200 to the second part 300. Corresponding bores355 may be aligned with the bores 217 of the first part 200 so that theset screws 357 or ball plungers 700 may extend through both the firstand second parts 200, 300 (FIG. 3).

As viewed in FIGS. 8 and 9, a ball plunger 700 is shown securing thebase 110 to the sleeve part 600. Such a ball plunger 700 couldoptionally be replaced by a set screw 357. Each ball plunger 700,including those in the first part 200, the second part 300 and/or base110, has an externally threaded tubular body 702 with a cylindricalcavity 704 located therein. The cavity 704 houses a projection 706 and aspring 708. The spring 708 may be of any suitable construction and urgeseach projection 706 against a lip portion 709 of the body 702. The lipportion 709 is located at one end of the cavity 704. Each ball plunger700 has projections 706 with spherical detent members 720 and shoulderportions 722.

Each ball plunger 700 further includes a head portion 730 with a slot732 for receiving a tool, such as a screwdriver. Each ball plunger 700may be threadedly adjusted within a threaded bore to alter the distancethat the spherical detent member 720 projects away from the associatedthreaded bore. This distance, along with the stiffness of each spring708, will determine a holding force applied by the ball plunger 700.

As viewed in FIG. 3, the screw mechanism 400 provides for verticaladjustment of the second part 300 relative to the base 110 parallel tothe central axis 14 of the cannula 10. The screw mechanism 400 includesa first large diameter spindle 410, a second small diameter spindle 420,and a thumb wheel 430. The thumb wheel 430 and the first spindle 410rotate about a secondary axis 404 parallel to the central axis 14 andspaced apart from the central axis. The first spindle 410 and the thumbwheel 430 may be made of plastic and integrally molded together as onepiece. The right-hand threaded bore 134 of the base part 132, the firstspindle 410, the second spindle 420, and the thumb wheel 430 are allsymmetric about the secondary axis 404.

The first spindle 410 has right-hand male threads 411 for engaging thefemale threads of the right-hand threaded bore 134 of the base part 132.As the first spindle 410 is rotated, due to manual force applied to thethumb wheel 430, about the secondary axis 404, the first spindle 410moves axially along the secondary axis vertically into, or out of, theright-hand threaded bore 134 depending upon the direction of rotation.The second spindle 420 has opposite left hand male threads 421 forengaging female threads of a left-hand threaded bore 415 centered on thesecondary axis 404 and located within the first spindle 410.

The upper end of the second spindle 420 has the part 423 that is arectangular, planar end portion inserted into the slot 323 of the secondpart 300. Instead of the cylindrical pin 305, set screws 357 orpreferably ball plungers 700 threaded into the bores 335, 336 in thesecond part 300, may alternatively engage planar surfaces of the endportion 423 and secure (along with the tracks 171, 172 of the base 110)the second part 300 against rotational movement relative to the secondspindle 420. The cylindrical pin 305, set screws 357, or ball plungers700 releasably secure the second part 300 against axial movementrelative to the end portion 423 of the second spindle 420.

If set screws 357 or ball plungers 700 are used, the end portion 423 ofthe second spindle 420 may alternatively have hemispherical recesses(not shown) for receiving the end of the set screws or the sphericaldetent members 720 of the ball plungers. The second spindle 420 may beremoved from the slot 323 of the second part 300 by removing thecylindrical pin 305, by disengaging the ends of the set screws 357 fromthe hemispherical recesses, or by overcoming the bias of the sphericaldetent members 720 in the hemispherical recesses.

As viewed in FIG. 3, the stop member 147 may alternatively be replacedby a stop structure, or limit structure 450, located internal to thefirst spindle 410. The limit structure includes a generally cylindricalshoulder portion 452 extending radially outward from the lower end ofthe second spindle 420 and a lip portion 451 extending radially inwardfrom the upper end of the first spindle 410. As the second spindle 420is threaded upward relative to the first spindle 410, it will reach aposition where the shoulder portion 452 will abuttingly engage the lipportion 451 of the first spindle and thereby prevent the second spindlefrom becoming disengaged from the first spindle. The second spindle 420can not be raised past this position relative to the first spindle 410.

The thumb wheel 430 has a knurled perimeter 431 to facilitate manualrotation of the thumb wheel about the secondary axis 404. When rotationis imparted to the thumb wheel 430, the threaded engagement between theright-hand female threads of the right-hand threaded bore 134 of thebase 130 and the right-hand male threads 411 of the first spindle 410either raises or lowers the first spindle vertically relative to thebase 110 depending upon the direction of rotation. Simultaneously, thethreaded engagement between the left-hand female threads of theleft-hand threaded bore 415 of the first spindle 410 and the left-handmale threads 421 of the second spindle 420 either raises or lowers(depending on the direction of rotation) the second spindle verticallyrelative to the first spindle. This opposite hand thread arrangementresults in an amplified movement of the second spindle 420 for eachsingle rotation of the thumb wheel 430 because the two sets of threadswork in concert to axially move the first spindle 410 and second spindlein the same direction, instead of acting against each other as wouldoccur if the threads were both left-hand or both right-hand.

The second part 300, being secured to the end portion 423 of the secondspindle 420, is moved linearly parallel to the axis 14 of the cannula 10(or vertically) upon rotation of the thumb wheel 430. The second part300 slides along the linear tracks 171, 172 of the guide portion 130with the stop member 147 or limit structure 450 providing an upper limitfor the position of the second part 300. As the second part 300 moves,the tracks 171, 172 may engage the lateral surfaces 331, 332 of thesecond part 300 and block rotation of the second part about thesecondary axis 404. Further, the tracks 171, 172 guide the verticalmovement of the second part 300. Upon vertical movement of the secondpart 300 relative to the base 110, the camera head 99 (and first part200) are thereby vertically adjusted, since they are secured in thepassage in the second part 300, as described above.

As viewed in FIG. 7, the cannula clamp 500 includes two gripper arms511, 512 that are deflected toward each other to clamp against the outersurface 28 of the cannula 10, a gripper actuating lever 520 fordeflecting the gripper arms into gripping engagement with the outersurface of the cannula, and an adjustment mechanism 530 for changing therelative position of the gripper arms from which the arms are moved bythe actuating lever to enable the arms to clamp different diametercannulas. The gripper actuating lever 520 also releases the gripper arms511, 512 from gripping engagement with the outer surface 28 of thecannula 10. When released, the gripper arms 511, 512 will spring awayfrom the outer surface 28 of the cannula 10. The two gripper arms 511,512 may grip the plastic tubing 32 depending on the position of theplastic tubing on the first tubular portion 20 of the cannula 10 (asdescribed above). References in this application to gripping the outersurface 28 of the cannula 10 are meant to also cover the gripper arms511, 512 engaging the plastic tubing 32.

The adjustment mechanism 530 includes a threaded stud 532 with alongitudinal axis, an adjustment knob 538 with a female threaded bore,and a lock pin 542. The threaded stud 532 has a head 534, a threadedshaft 536 for screwing into, and through, the threaded bore of theadjustment knob, and an oblong, or flat end 537 which extends through anoblong bore 515 in the gripper arm 511. Alternative structures for theadjustment mechanism 530 are envisioned by the present invention.

During assembly, the flat end 537 of the threaded stud 532 is threadedthrough the bore of the adjustment knob 538 and inserted horizontallythrough a circular bore (not shown) in the gripper arm 512 that islarger in diameter than the diameter of the threaded stud and throughthe oblong bore 515 in the gripper arm 511. The flat end 537 of thethreaded stud 532 is then horizontally (as viewed in FIGS. 4 and 7)inserted into a longitudinal slot 525 in the lever 520. The threadedstud 532 is secured against rotation relative to gripper arms 511, 512by engaging surfaces of the gripper arm defining the oblong bore 515 ongripper arm 511. The lock pin 542 is then inserted vertically through abore (not shown) in the lever 520 and through a bore (not shown) in theflat end 537 of the threaded stud 532 thereby securing the adjustmentmechanism 530 together. The lever 520 is free to rotate about the lockpin 542.

The adjustment knob 538 may be axially positioned along the threadedstud 532 by rotation of the adjustment knob about the secured threadedstud. By changing the axial position of the adjustment knob 538, thegripper arm 512 moves relative to the threaded stud 532 and the distancebetween the gripper arms 511, 512 changes and the relative positions ofthe gripper arms change. Rotation of the adjustment knob 538 in onedirection may move the gripper arms 511, 512 closer together androtation in the opposite direction may allow the arms to spring apart.

A camming surface 522 on the lever 520, adjacent the gripper arm 511,moves the arms 511, 512 a predetermined distance together to grip theouter surface 28 of the cannula 10 as the lever is rotated clockwiseabout the lock pin 542 to the position shown in FIG. 12.Counterclockwise rotation of the lever 520 about the lock pin 542, fromthe position shown in FIG. 12, allows the gripper arms 511, 512 tospring (move) apart and releases the outer surface 28 of the cannula 10from the cannula clamp 500.

The gripper arms 511, 512 have a normal position from which the gripperarms may be moved a predetermined distance by the actuating lever 520 togrip a cannula having a first diameter. Rotation of the adjustment knob538 in one direction relative to the stud 532 causes arms 511, 512 toresiliently deflect toward each other and take new positions. Thegripper arms 511, 512 may be moved from these new positions apredetermined distance by the actuating lever 520 to grip a cannulahaving a second diameter smaller than the first diameter. Rotation ofthe adjustment knob 538 in a second direction opposite the firstdirection allows the gripper arms 511, 512 to spring back toward theirnormal positions. The adjustment knob 538 enables the cannula clamp 500to securely grip cannulas of different diameters.

When the cannula clamp 500 is released from the cannula 10, the base 110and parts (i.e., the camera head 99, the endoscope, etc.) attached tothe base may move axially along the central axis 14 of the cannula 10relative to the cannula. After the apparatus 100 is initially alignedwith the cannula 10, the camera head 99 may be positioned on theapparatus 100 and axially adjusted along the central axis 14 in thismanner. When the cannula clamp 500 is gripping the outer surface 28 ofthe cannula 10, the screw mechanism 400 provides for vertical (axial)adjustment of the camera head 99 relative to the cannula.

As viewed in FIG. 1, the cylindrical sleeve part 600, which is securedto the cannula clamp 500, may be inserted into the central aperture 125of the base 110. The sleeve part 600 has a passage extending through thesleeve part, which passage receives the cannula 10. As viewed in FIG. 4,the upper edges of the sleeve part 600 and the proximal end 22 of thecannula 10 are typically assembled flush with the upper surface area121′ of the first disk 121. The sleeve part 600 is centered about thecentral axis 14 and includes a cylindrical outer surface 610, ahorizontal groove 620 that extends around the cylindrical outer surface,and a horizontal array of spaced apart recesses 630 in the cylindricalouter surface. The recesses 630 lie in a horizontal plane parallel to,and axially offset from, a plane defined by the groove 620, both planesbeing perpendicular to the central axis 14.

As viewed in FIG. 8, the sleeve part 600 is axially secured in thecentral aperture 125 of the base 110 by set screws 357 or, morepreferably, by ball plungers 700 extending radially into the centralaperture and engaging the groove 620. The sleeve part 600 isrotationally (and axially) secured in the central aperture 125 of thebase 110 by the set screws 357 or the ball plungers 700 extendingradially into the central aperture and being received in the recesses630. The set screws 357 or ball plungers 700 are threaded radiallyinward through threaded radial bores 127 that penetrate radially inwardfrom the second perimeter 124 of the base 110 to the central aperture125. Three radial bores 127′ are axially aligned with the groove 620 andare located at 120° increments about the central aperture 125. Fiveadditional radial bores 127″ are axially aligned with the recesses 630,three at 120° increments about the central aperture 125, but angularlyoffset 60° from the three bores 127′ and two at diametrically opposedlocations and offset 30° from two of the three bores 127″.

If set screws 357 are used, the distal ends of the set screws formdetents that engage the groove 620 and support the sleeve part 600 inthe central aperture 125, but allow the base 110 and sleeve part torotate relatively to the base about the central axis 14. The recesses630 of the sleeve part 600 and the detents formed by set screws 357 forman indexing mechanism that secures the sleeve part at selected angularincrements about the central axis 14 relative to the base 110.Thirty-six (36) recesses 630 are spaced about the cylindrical outersurface 610 at 10° increments. Thus, when the set screws 357 arethreadedly disengaged from the recesses 630, the base 110 may be rotatedabout the central axis 14 relative to the cannula clamp 500 and thecannula secured thereto, while the base 110 is axially secured by theset screws 357 engaging the groove 620. After 10° of rotation (or somemultiple of 10°), the set screws 357 may be threaded inward forreengaging the recesses 630 and rotationally securing the base 110 tothe cannula clamp 500 and the cannula 10. An access bore 128 is locatedin the base part 132 of the guide portion 130 for providing access tothe bore 127′ that is disposed within the guide portion 130 of the base110.

If ball plungers 700 are used, which is preferable, the spherical detentmembers 720 form detents that engage the groove 630 and support thesleeve part 600 in the central aperture 125, but allow the base 110 andthe sleeve part to rotate about the central axis 14. The recesses 630 ofthe sleeve part 600 and the detents formed by ball plungers 700 form anindexing mechanism that secures the sleeve part at selected angularincrements about the central axis 14 relative to the base 110.Thirty-six (36) recesses 630 are spaced about the cylindrical outersurface 610 at 10° increments. Thus, with minimal manual force toovercome the biasing force of the ball plungers 700, the base 110 may berotated about the central axis 14 relative to the cannula clamp 500 andthe cannula 10 secured thereto, thereby disengaging the biased sphericaldetent members 720 from the recesses 630. The base 110 will remainaxially secured by the ball plungers 700 engaging the groove 620. Thespherical detent members 720 reengage the recesses after 10° ofrotation. The ball plungers 700 may be further secured in the bores 127of the base 110 by adhesive being applied to the externally threadedtubular bodies 702 near each head portion 730.

However, if rotation of the base 110 more than 10° is desired, themanual force applied to the base can continue to rotate the baserelative to the cannula clamp 500 and the cannula 10. As should beapparent, the base 110 and the camera head 99 (and the attachedendoscope) may rotate at least 300° about the central axis 14 of thecannula 10 and be adjustably fixed at 10° increments. This enables thesurgeon to view different parts of the surgical site, as desired. Thesleeve part 600 of the cannula clamp 500 can be easily removed from thecentral aperture 125 for cleaning, maintenance, etc. of the parts bydisengaging the set screws 357 from the groove 620 and the recesses 630,or by overcoming the biasing force applied by the ball plungers 700 tothe sleeve part.

As viewed in FIGS. 10-12, the cannula clamp 500 is a part of the supportarm 900 for attaching the apparatus 100 to a mechanical robotic arm 901.The support arm 900 includes an arm portion 902 which may be formedintegrally with the gripper arms 511, 512. As viewed in FIG. 4, the armportion 901 extends upwardly away from the gripper arms 511, 512 inorder to minimize the possibility of contact with the patient duringsurgery.

The support arm 900 also includes an arm portion 903. The arm portion903 has an attaching structure 904, including a groove 905, which snapsinto a socket in the mechanical arm 901. Detents of any suitable typeand designated 906 in the mechanical arm 901, hold the arm portion 903in position in the socket in the mechanical arm 901. The detents 906 maybe controlled by external actuation levers (not shown) on the mechanicalarm 901 for manually releasing the arm portion 903 from the mechanicalarm 901.

The arm portions 902, 903 are pivotally connected to each other by afastener 910. The fastener 910 extends through an opening 911 in the armportion 902 and threads into a threaded opening 912 in the arm portion903. When the fastener 910 is released, the arm portions 902, 903 maypivot relative each other about a pivot axis 914. The pivot axis 914 iscentered on the axis of the fastener 910 and the axis of the threadedopening 912. When the fastener 910 is tightly screwed into the threadedopening 912, the arm portions 902, 903 are secured together againstpivoting movement. When the fastener 910 is released, the arm portions903, 902 may pivot relative to each other about the axis 914.

The end of the arm portion 902, which is adjacent to the arm portion903, has a convex surface 950, which is curved about the axis 914. Thearm portion 903 has a concave surface 951, which is also curved aboutthe axis 914. The surfaces 950, 951 move concentrically relative to eachother when the arm portions 902, 903 pivot relatively about the axis914.

The arm portion 903 has a set of teeth 920 which encircle the axis 914and which project axially toward a set of teeth 921 on the arm portion902. The teeth 921 project axially toward the teeth 920. The teeth 920and the teeth 921 mesh with each other and provide a locking action sothat the arm portions 902, 903 are positively locked against relativemovement about the axis 914 when the fastener 910 is tightly screwedinto the opening 912. The teeth 920, 921 define a lock which blocksrelative rotation of the arm portions 902, 903 about the axis 914. Whenthe fastener 910 is loosened, the arm portions 902, 903 may be rotatedrelative to each other about the axis 914, and thus, the arm portions902, 903 may pivot relative to each other to adjust the position of theapparatus 100.

A cylindrical projection 925 is welded to the arm portion 903. Thus, theprojection 925 and arm portion 903 are fixedly connected together. Theprojection 925 is centered on the axis 914 and contains a chamber 928.

As viewed in FIG. 12, the chamber 928 communicates with a fluid passage929 in a male fluid connector 931. The male connector 931 attaches to amale connector 933 on the mechanical arm 901 by means of a flexible hose992 so that the fluid passage 929 communicates with a fluid passage inthe mechanical arm 901.

As viewed in FIG. 10, the chamber 928 is closed at its upper end by acap 935. The cap 935 has an opening 936 centered on the axis 914. Theopening 936 communicates with the chamber 928. A manually movableinternal valve member 940 normally closes the opening and blocks thechamber 928 from communicating with the ambient air surrounding thesupport arm 900. The valve member 940 is connected to a stem 941, whichis also centered on the axis 914. The stem 941 has a knob or button 943on its end that may be manually depressed to move the stem 941 and valvemember 940 downward (as viewed in FIG. 10) into the chamber 928. Whenthe stem 941 and valve member 940 are so moved, the chamber 928 is incommunication with the ambient air surrounding the device due to theunblocking of the opening 936.

The mechanical arm 901 is a known device and is of the type generallydisclosed in U.S. Pat. No. 4,863,133. The mechanical arm 901 is sold byLeonard Medical, Inc. 1464 Holcomb Road, Huntington Valley, Pa., 19006.The mechanical arm 901 includes relatively movable parts, which permitmovement and adjustment of the apparatus 100 in a variety in planes,directions, and orientations. The mechanical arm 901 permits easymovement when a vacuum is not applied to the arm 901. When a vacuum isapplied to the arm 901, relative movement of the parts of the arm isresisted, and therefore adjustment of the apparatus 100 is difficult.

When the button 943 is depressed, the chamber 928 loses its vacuum andthe pressure in the chamber increases toward ambient pressure. Thepassage 929 communicates this pressure increase to the mechanical arm901, and thus the parts of the mechanical arm are free to move and allowfor adjustment of the position of the apparatus 100 by the surgeon.

Accordingly, when the surgeon uses the apparatus 100, the support arm900 is snapped into the socket of the mechanical arm 901 where it isheld by the detent 906. The surgeon may then depress the button 943 andrelatively move parts of the mechanical arm 901 as well as the apparatus100 into the position where the surgeon desires the apparatus to be.This position may be where the central aperture 125 of the base 110 andthe sleeve portion 600 are aligned with the proximal end 22 of thecannula 10 and the distal end 24 of the cannula 10 is located in anincision in the body of a patient. The camera head 99 (and theendoscope) may be mounted on the apparatus 100, and the surgeon may makeadjustments prior to, and during, the surgical procedure as desired, asdescribed above.

As viewed in FIG. 4, the fixed connection of the sleeve portion 600 tothe support arm 900 may be made by the fasteners 599. The sleeve part600 is axially offset from the gripper arms 511, 512 in order to allowthe gripper arms to flex against the outer surface 28 of the cannula 10.

As viewed in FIG. 13, the sleeve part 600 may have an annular retaininglip 641 for engaging the proximal end 22 of the cannula 10. Theretaining lip 641 extends radially inward toward the axis 14 andprovides an upper limit stop that prevents the cannula 10 from extendingupward (axially) from the central aperture 125. The upper edge of theretaining lip 641 is mounted flush with the upper surface area 121′ ofthe first disk 121.

As viewed in FIGS. 13 and 14, the cannula 10 may be further axiallysecured within the sleeve part 600 by a cannula retainer structure 1000(along with the retaining lip 641) located near the retaining lip at aninner surface 611 of the sleeve part 600. The retainer structure 1000includes a first retention groove 1010 disposed on the inner surface 611of the sleeve part 600, a corresponding second retention groove 1020disposed in the outer surface 28 of the proximal end 22 of the cannula10, and a split ring member 1030 for engaging both the first and secondretention grooves. As viewed in FIG. 14, the split ring member 1030(constructed of a metal such as steel) has a gap 1040. The ring member1030, when located in retention groove 1010, may flex radially outwardwhen the cannula 10 is axially inserted into the sleeve part 600 andinto the ring member 1030. The outer surface 28 of the cannula 10 forcesthe ring member 1030 radially outward. The ring member 1030 then flexesback radially inward into the groove 1020 on the cannula 10 when theretention grooves 1010, 1020 are aligned. The ring member 1030 therebyaxially secures the cannula 10 to the apparatus 100.

As viewed in FIGS. 15 and 16, the sleeve part 600, cannula clamp 500,and arm portion 902 may be replaced in an apparatus 100′ by analternative sleeve part 1100, a first arm portion 1110, and second armportion 1120. The sleeve part 1100 is similar to the sleeve part 600 ofFIGS. 1-14 except that it is not secured to the arm portion 902 by thefasteners 599. The sleeve part 1100 is a cylindrical tube symmetricabout a central axis. The first arm portion 1110 has a first end 1111with a sleeve retainer comprising a ring member 1113, that is press fitonto an outer surface 1101 of the lower end of the sleeve part 1100. Thefirst arm portion 1110 may be constructed of an electrically insulatingmaterial such as plastic so that no electric charge is carried acrossthe first arm portion. The sleeve 1100 is thus electrically insulatedfrom the second arm portion 1120.

A second end 1112 of the first arm portion 1110 is secured to one end1121 of the second arm portion 1120 by fasteners 1119, such as bolts orrivets. The opposite end 1122 of the second arm portion 1120 has thesame configuration as that of the arm portion 902.

As viewed in FIG. 24, the sleeve part 600 of FIG. 13 may, instead of thesplit ring member 1030, alternatively have two diametrically opposedslots 1051 for increasing radial flexibility of the sleeve part 600. Theouter surface 28 of the cannula 10 is slightly larger in diameter thanthe inner diameter of the inner surface 611 of the sleeve part 600. Thecannula 10 is thereby frictionally secured within the sleeve part 600 bythe clamping engagement of the sleeve part against the outer surface 28of the cannula. The slots 1051 each have end portions 1052 that are openat the lower end of the sleeve part 600.

As viewed in FIG. 17, the inner surface 611 of the sleeve part 600 mayfurther include an internal annular bead 1061 for engaging the outersurface 28 of the cannula 10. The internal diameter of the bead 1061 maybe less than the outer diameter of the cannula 10. When the cannula 10is inserted into the sleeve part 600, the internal diameter of thesleeve part 600 and the internal bead 1061 may increase to accommodatethe cannula. After a retention groove of the cannula 10 reachesalignment with the internal bead 1061 of the sleeve part 600, the sleevepart can spring back toward its original diameter with the bead 1061located in the retention groove on the cannula thereby axially securingthe cannula within the sleeve part.

If the alternative internal bead feature 1061 is not used, a cannulawith no groove may also be used. In this case the internal diameter ofthe sleeve 600 may be less than the outer diameter of the cannula 10.Thus, the sleeve part 600 would be expanded on insertion of the cannula10 and would grip the outer surface 28 of the cannula.

As viewed in FIGS. 15, 16, and 18, the apparatus 100′ incorporates thealternative features of FIGS. 13 and 14 into the apparatus of FIGS.1-12. The same numbering is applied to the apparatus 100′ as thatapplied to the apparatus 100.

The entire apparatus 100 or 100′ can be constructed from metal or anyother suitable material having sufficient mechanical strength,flexibility, and durability. Certain parts may be made from materialspermitting X-rays and other techniques for viewing the surgical site(i.e., radiopaque parts). Other parts may also be made from non-magneticmaterials to reduce electromagnetic interference (i.e., electromagneticinsulating parts).

From the above description of the invention, those skilled in the artwill perceive improvements, changes and modifications. Suchimprovements, changes and modifications within the skill of the art areintended to be covered by the appended claims.

Having described the invention, the following is claimed:
 1. Anapparatus for supporting an endoscope for viewing a surgical site in apatient during surgery on the patient, the endoscope extending through acannula into the patient, said apparatus comprising: a base; and acannula retainer for engaging an outer surface of the cannula to securethe cannula to said cannula retainer, said cannula retainer including asplit ring for engaging a groove on the outer surface of the cannula anda sleeve for receiving the cannula and supporting said split ring, saidbase being rotatable relative to said sleeve about an axis of thecannula.
 2. The apparatus as set forth in claim 1 wherein said baseincludes a guide portion, and further including a first part to be fixedto the endoscope and a second part engaging said guide portion, saidfirst and second parts being movable together relative to said guideportion.
 3. The apparatus as set forth in claim 1 further including asleeve retainer for supporting said base and said sleeve, said sleeveretainer including a ring member press fit onto an end portion of saidsleeve.
 4. The apparatus as set forth in claim 1 wherein said sleeve hasat least one slot and an initial internal diameter that increases as thecannula is inserted into said sleeve such that said sleeve clampsagainst the cannula.
 5. The apparatus as set forth in claim 1 whereinsaid sleeve has an annular retaining lip for engaging an upper end ofthe cannula and limiting axial movement of the cannula relative to saidsleeve.
 6. The apparatus as set forth in claim 4 wherein said sleeveincludes an annular bead disposed on a inner surface of said sleeve,said annular bead being adapted to secure the cannula to said sleeve. 7.An apparatus for supporting an endoscope for viewing a surgical site ina patient during surgery on the patient, the endoscope extending into acannula and into the patient, said apparatus comprising: a base forsupporting the endoscope; a sleeve for receiving the cannula, said baseand said sleeve being relatively rotatable about an axis of the cannula;and a support arm for securing said sleeve to a support structure, saidsupport arm including a first portion for connection to said sleeve anda second portion for interconnecting said first portion and the supportstructure, said first portion comprising an electrically insulatingmaterial electrically insulating said sleeve from said second portion.8. The apparatus as set forth in claim 7 further including a first partto be fixed to the endoscope and a second part adjustably engaging saidbase, said first part and said second part being vertically movabletogether relative to said base.
 9. The apparatus as set forth in claim 8wherein said sleeve has an annular retaining lip for engaging an upperend of the cannula and limiting axial movement of the cannula relativeto said sleeve, said annular retaining lip extending radially inwardtoward the axis of the cannula.
 10. The apparatus as set forth in claim7 wherein said sleeve is part of a cannula retainer, said cannularetainer further including a split ring for engaging a first groove onthe outer surface of the cannula and a second groove on an inner surfaceof said sleeve.
 11. The apparatus as set forth in claim 10 furtherincluding a connection between said base and said sleeve, saidconnection enabling said base to rotate relative to said sleeve aboutthe axis of the cannula, said connection including an index mechanismwith parts interposed between said base and said sleeve for retainingsaid base at incremental relatively rotated positions relative to saidsleeve.
 12. The apparatus as set forth in claim 7 wherein said sleevehas an annular bead and at least one slot such that an initial internaldiameter of said annular bead can increase as a cannula is inserted intosaid sleeve and subsequently spring back toward said initial diameter.13. An apparatus for supporting an endoscope for viewing a surgical sitein a patient during surgery on the patient, said apparatus comprising: abase having a guide portion; a first part to be fixed to an endoscope, asecond part movable in said guide portion and connected with said firstpart, said first and second parts being movable together relative tosaid guide portion; a screw mechanism connected to said second art andoperable to move said first and second parts relative to said guideportion; and a pin for securing said second part to said screwmechanism, said pin being press fit into recesses in both said secondpart and said screw mechanism.
 14. The apparatus as set forth in claim13 further including a cannula retainer engaging an outer surface of acannula and securing said cannula to said cannula retainer, said cannularetainer including a sleeve for receiving said cannula and a split ringfor engaging a groove on said outer surface of said cannula.
 15. Theapparatus as set forth in claim 14 wherein said sleeve has an annularretaining up for engaging an upper end of the cannula and limiting axialmovement of the cannula relative to said sleeve.
 16. The apparatus asset forth in claim 14 further including a connection between said baseand said sleeve, said connection enabling said base to rotate relativeto said sleeve about an axis of said sleeve, said connection includingan index mechanism with arts interposed between said base and saidcannula for retaining said base at incremental relatively rotatedpositions relative to said sleeve.
 17. The apparatus as set forth inclaim 13 further including a sleeve for engaging an outer surface of acannula, said sleeve and said base being relatively rotatable about anaxis of the cannula.
 18. The apparatus as set forth in claim 17 furtherincluding a sleeve retainer for supporting said sleeve and said base,said sleeve retainer including a ring member press fit onto an endportion of said sleeve.
 19. The apparatus as set forth in claim 13further including a cylindrical sleeve for engaging an outer surface acannula, said sleeve having an internal bead having an internal diameterthat increases from an initial diameter as the cannula is inserted intosaid sleeve and that subsequently springs back toward said initialdiameter.
 20. An apparatus for supporting an endoscope for viewing asurgical site in a patient during surgery on the patient, said apparatuscomprising: a base having a guide portion; a structure adapted to befixed to the endoscope, said structure engaging said guide portion andbeing movable relative to said guide portion; and a screw mechanismconnected between said base and said structure, at least a portion ofsaid screw mechanism being rotatable to slide said structure relative tosaid guide portion to change a position of the endoscope relative to thepatient, said screw mechanism including a first threaded spindle havingfemale threads and a second threaded spindle rotatable about an axisrelative to said female threads in said first threaded spindle, saidfirst threaded spindle having a lip portion for limiting axialdisplacement of said first threaded spindle relative to said secondthreaded spindle.
 21. The apparatus as set forth in claim 20 whereinsaid structure comprises a first part adapted to be fixed to theendoscope and a second part vertically movable relative to said guideportion, said first and second parts being movable together relative tosaid guide portion.
 22. The apparatus as set forth in claim 20 furtherincluding a sleeve engaging an outer surface of a cannula, and a splitring supported by said sleeve for engaging a groove on said outersurface of said cannula.
 23. The apparatus as set forth in claim 22further including a connection between said base and said sleeve, saidconnection enabling said base to rotate relative to said sleeve about anaxis of said cannula, said connection including an index mechanism withparts interposed between said base and said cannula for retaining saidbase at incremental relatively rotated positions relative to saidcannula.
 24. The apparatus as set forth in claim 22 further including asleeve retainer for supporting said base and said sleeve, said sleeveretainer including a ring member press fit onto an end portion of saidsleeve.
 25. An apparatus for supporting an endoscope that extendsthrough a cannula for viewing a surgical site in a patient duringsurgery on the patient, said apparatus comprising: a base forassociation with the cannula, said base having a guide portion; a firstpart adapted to be fixed to the endoscope; a second part engaging saidguide portion and being movable relative to said guide portion, saidfirst and second parts being movable together relative to said guideportion; a mechanism connected between said base and said second partfor moving said first and second parts relative to said guide portion tochange a position of the endoscope relative to the patient; and acannula retainer for engaging an outer surface of the cannula to securethe cannula to said cannula retainer, said cannula retainer including asplit ring for engaging a groove on the outer surface of the cannula anda sleeve supporting said split ring.
 26. The apparatus as set forth inclaim 25 further including a connection between said base and saidsleeve, said connection enabling said base to rotate relative to saidsleeve about an axis of the cannula, said connection including an indexmechanism with parts interposed between said base and said sleeve forretaining said base at incremental relatively rotated position relativeto said sleeve.
 27. The apparatus as set forth in claim 25 wherein saidsleeve engages an outer surface of the cannula, said sleeve and saidbase being relatively rotatable about an axis of the cannula.
 28. Theapparatus as set forth in claim 27 wherein said sleeve has an annularretaining lip for engaging an upper end of the cannula and limitingaxial movement of the cannula relative said sleeve, said annularretaining lip extending radially inward toward an axis of the cannula.29. The apparatus as set forth in claim 27 further including a sleeveretainer for supporting said base and said sleeve, said sleeve retainerincluding a member press fit onto an end portion of said sleeve.
 30. Anapparatus for supporting an endoscope that extends through a cannula forviewing a surgical site in a patient during surgery on the patient, saidapparatus comprising: a base for association with the cannula, said basehaving a guide portion; a first part adapted to be fixed to theendoscope; a second part engaging said guide portion and being movablerelative to said guide portion, said first and second parts beingmovable together relative to said guide portion; a mechanism connectedbetween said base and said second part for moving said first and secondparts relative to said guide portion to change a position of theendoscope relative to the patient; and a sleeve for engaging the cannulaand a support arm for securing said sleeve to a support structure, saidsupport arm including a first portion for connection to said sleeve anda second portion for interconnecting said first portion and the supportstructure, said first portion comprising an electrically insulatingmaterial electrically insulating said sleeve from said second portion.31. An apparatus for supporting an endoscope that extends through acannula for viewing a surgical site in a patient during surgery on thepatient, said apparatus comprising: a base for association with thecannula, said base having a guide portion; a first part adapted to befixed to the endoscope; a second part engaging said guide portion andbeing movable relative to said guide portion, said first and secondparts being movable together relative to said guide portion; and amechanism connected between said base and said second part for movingsaid first and second parts relative to said guide portion to change aposition of the endoscope relative to the patient; said first partincluding at least one rail member for slidably engaging a guide trackof said second part.
 32. An apparatus for supporting an endoscope thatextends through a cannula for viewing a surgical site in a patientduring surgery on the patient, said apparatus comprising: a base forassociation with the cannula, said base having a guide portion; a firstpart adapted to be fixed to the endoscope; a second part engaging saidguide portion and being movable relative to said guide portion, saidfirst and second parts being movable together relative to said guideportion; a mechanism connected between said base and said second partfor moving said first and second parts relative to said guide portion tochange a position of the endoscope relative to the patient; and acylindrical sleeve for receiving the cannula, said sleeve having atleast one slot and an initial internal diameter that increases as thecannula is inserted into said sleeve such that said sleeve clampsagainst the cannula.
 33. An apparatus for supporting an endoscope thatextends through a cannula for viewing a surgical site in a patientduring surgery on the patient, said apparatus comprising: a base forassociation with the cannula, said base having a guide portion; a firstpart adapted to be fixed to the endoscope; a second part engaging saidguide portion and being movable relative to said guide portion, saidfirst and second parts being movable together relative to said guideportion; and a mechanism connected between said base and said secondpart for moving said first and second parts relative to said guideportion to change a position of the endoscope relative to the patient,said mechanism including a first threaded spindle and a second threadedspindle rotatable about an axis relative to said first threaded spindle,said first threaded spindle having a lip portion for limiting axialdisplacement of said first threaded spindle relative to said secondthreaded spindle.
 34. The apparatus as set forth in claim 33 whereinsaid second threaded spindle has a radially extending shoulder portionfor engaging said lip portion of said first threaded spindle.
 35. Anapparatus for supporting an endoscope for viewing a surgical site in apatient during surgery on the patient, the endoscope extending through acannula into the patient, said apparatus comprising: a base forsupporting the endoscope; a sleeve for receiving the cannula, said baseand said sleeve being relatively rotatable about an axis of the cannula;a sleeve retainer for supporting said sleeve and said base, said sleeveretainer including a member press fit onto an end portion of saidsleeve; and a first part to be fixed to the endoscope and a second partfor slidably engaging said base, said first part and said second partbeing vertically movable together relative to said base.
 36. Anapparatus for supporting an endoscope for viewing a surgical site in apatient during surgery on the patient, the endoscope extending through acannula into the patient, said apparatus comprising: a base forsupporting the endoscope; a sleeve for receiving the cannula, said baseand said sleeve being relatively rotatable about an axis of the cannula;and a sleeve retainer for supporting said sleeve and said base, saidsleeve retainer including a member press fit onto an end portion of saidsleeve, said sleeve being a part of a cannula retainer, said cannularetainer further including a split ring for engaging a first groove onthe outer surface of the cannula and for engaging a second groove on aninner surface of said sleeve.
 37. An apparatus for supporting anendoscope for viewing a surgical site in a patient during surgery on thepatient, the endoscope extending through a cannula into the patient,said apparatus comprising: a base for supporting the endoscope; a sleevefor receiving the cannula, said base and said sleeve being relativelyrotatable about an axis of the cannula; and a sleeve retainer forsupporting said sleeve and said base, said sleeve retainer including amember press fit onto an end portion of said sleeve, said sleeveretainer comprising an electrically insulating material electricallyinsulating said sleeve.
 38. An apparatus for supporting an endoscope forviewing a surgical site in a patient during surgery on the patient, theendoscope extending through a cannula into the patient, said apparatuscomprising: a base for supporting the endoscope; a sleeve for receivingthe cannula, said base and said sleeve being relatively rotatable aboutan axis of the cannula; and a sleeve retainer for supporting said sleeveand said base, said sleeve retainer including a member press fit onto anend portion of said sleeve; said sleeve having an initial internaldiameter that increases as the cannula is inserted into said sleeve suchthat the sleeve clamps against the cannula.
 39. An apparatus forsupporting an endoscope for viewing a surgical site in a patient duringsurgery on the patient, the endoscope extending through a cannula intothe patient, said apparatus comprising: a base for supporting theendoscope; a sleeve for receiving the cannula, said base and said sleevebeing relatively rotatable about an axis of the cannula; a sleeveretainer for supporting said sleeve and said base, said sleeve retainerincluding a member press fit onto an end portion of said sleeve; and amechanism for axially adjusting the endoscope relative to said base,said mechanism including a first threaded spindle and a second threadedspindle rotatable about an axis relative to said first threaded spindle,said first threaded spindle having a lip portion for limiting axialdisplacement of said first threaded spindle relative to said secondthreaded spindle.
 40. The apparatus as set forth in claim 39 whereinsaid second threaded spindle has a radially extending shoulder portionfor engaging said lip portion of said first threaded spindle.
 41. Anapparatus for supporting an endoscope for viewing a surgical site in apatient during surgery on the patient, the endoscope extending through acannula into the patient, said apparatus comprising: a base forsupporting the endoscope; a sleeve for engaging an outer surface of thecannula, said base and said sleeve being relatively rotatable about anaxis of the cannula, said sleeve having an internal diameter thatincreases from an initial diameter as the cannula is inserted into saidsleeve and that subsequently springs back toward said initial diameterso that said sleeve grips the cannula, said sleeve being part of acannula retainer, said cannula retainer further including a split ringfor engaging a groove on the outer surface of the cannula.
 42. Theapparatus as set forth in claim 41 further including a connectionbetween said base and said sleeve, said connection enabling said base torotate relative to said sleeve about the axis of the cannula, saidconnection including an index mechanism with parts interposed betweensaid base and said sleeve for retaining said base at incrementalrelatively rotated positions relative to said sleeve.
 43. An apparatusfor supporting an endoscope for viewing a surgical site in a patientduring surgery on the patient, the endoscope extending through a cannulainto the patient, said apparatus comprising: a base for supporting theendoscope; a sleeve for engaging an outer surface of the cannula, saidbase and said sleeve being relatively rotatable about an axis of thecannula, said sleeve having an internal diameter that increases from aninitial diameter as the cannula is inserted into said sleeve and thatsubsequently springs back toward said initial diameter so that saidsleeve grips the cannula; and a sleeve retainer for supporting said baseand said sleeve, said sleeve retainer including a ring member press fitonto an end portion of said sleeve.
 44. An apparatus for supporting anendoscope for viewing a surgical site in a patient during surgery on thepatient, the endoscope extending through a cannula into the patient,said apparatus comprising: a base for supporting the endoscope; a sleevefor engaging an outer surface of the cannula, said base and said sleevebeing relatively rotatable about an axis of the cannula, said sleevehaving an internal diameter that increases from an initial diameter asthe cannula is inserted into said sleeve and that subsequently springsback toward said initial diameter so that said sleeve grips the cannula;and a support arm for securing said sleeve to a support structure, saidsupport arm including a first portion for connection to said sleeve anda second portion for interconnecting said first portion and the supportstructure, said first portion comprising an electrically insulatingmaterial